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Neurobrucellosis in Northern Iraq
Neurobrucellosis في شمال العراق

Author: Ismail D. Saeed* **Mohammad M. Fathi
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2013 Volume: 19 Issue: 1 Pages: 100-106
Publisher: Tikrit University جامعة تكريت

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Abstract

Neurobrucellosis is a rare neurological complication of brucellosis. This study describes 16 patients of neurobrucellosis which undoubtedly account for a small percentage of total admitted cases of brucellosis to Mosul city hospitals for tertiary care over a period of five years. The diagnosis was depended on history, clinical examination, positive brucella test, CSF examination and MRI or CT of the brain or spine. Headache, fever, sweating fatigue, drowsiness, neck stiffness, symptoms of cranial nerve involvement and backache were the common clinical features. Cerebrospinal fluid (CSF) showed an abnormal finding regarding increased cell count, elevated protein levels and low glucose in 9 patients and positive serology in 13 patients; while blood serology was highly reactive in all. The patients received a combination antibiotic therapy for 3 – 6 months. Patients with acute neurological complications as well as those with radiculoneuropathy responded favourably to treatment. The outcome was as follow: Eight patients recovered completely while other eight patients left with partial or complete disabilities. As neurobrucellosis is a fatal condition if remained untreated; doctors especially in endemic areas like Iraq should consider the likelihood of neurobrucellosis in patients with unexplained neurological and psychiatric symptoms.

Neurobrucellosis هو اختلاط عصبي نادر من مرض البروسيلا . توضح هذه الدراسة 16 مريضا من neurobrucellosis التي تمثل بلا شك لنسبة ضئيلة من مجموع الحالات اعترف من الحمى المالطية إلى مستشفيات المدينة لتلقي الرعاية الموصل العالي على مدى فترة خمس سنوات. و يعتمد التشخيص على التاريخ، و الفحص السريري واختبار البروسيلا إيجابية ، والتصوير بالرنين المغناطيسي فحص السائل النخاعي أو المقطعية للدماغ أو العمود الفقري. والصداع، و الحمى ، والتعرق والتعب، و النعاس ، وتصلب الرقبة، و كانت أعراض تورط العصب القحفي و آلام الظهر المظاهر السريرية شيوعا . أظهرت السائل النخاعي (CSF ) و النتيجة غير طبيعية فيما يتعلق بزيادة عدد خلايا ، ومستويات مرتفعة من البروتين والجلوكوز المنخفضة في 9 مرضى و الأمصال إيجابية في 13 مريضا ؛ بينما كان الأمصال الدم شديدة التفاعل في كل شيء. تلقى المرضى العلاج المركب المضاد الحيوي لمدة 3 - 6 أشهر . المرضى الذين يعانون من مضاعفات عصبية حادة ، فضلا عن أولئك الذين لديهم اعتلال الجذور و الأعصاب استجابت للعلاج. كانت النتيجة على النحو التالي : تعافى ثمانية مرضى تماما حين ترك غيرها من ثمانية مرضى ذوي الإعاقة جزئية أو كاملة. كما neurobrucellosis هو شرط قاتلة إذا بقيت دون علاج ؛ يجب على الأطباء وخاصة في المناطق الموبوءة مثل العراق النظر في احتمال neurobrucellosis في المرضى الذين يعانون من أعراض عصبية و نفسية غير المبررة .


Article
Neurobrucellosis: Antimicrobial Treatment of Six Complicated Cases of Brucellosis

Author: Abdulridha Al-Abbasi
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 1 Pages: 59-64
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Brucellosis is a classical zoonosis; it is a common disease in the Middle East countries. Involvement of the Central Nervous System by Brucella microorganisms might be not uncommon and is parallel to the prevalence rate of the disease among population. The work reported here is for six cases with brucella meningoencephalitis diagnosed by isolation of Brucella microorganisms from their blood and spinal fluid together, with high anti-brucella antibodies in their blood and Cerebro Spinal Fluid (CSF). Cases of PUO admitted to Fever Hospital and Neurological unit in the Medical City Teaching Hospital were evaluated clinically and neurologically. Six cases (three males and three females) suspected of neurological involvement by the disease all had fever, sweating +/- joint pains, all had meningeal irritation signs, abnormal CSF findings and all had history of raw milk &/or cheese consumption. They all were treated by different courses of many antibiotics for different times with skeptical responses. The general complaint was varying between fever, vomiting, weight loss, severe depression, headache and sweating, one case had change of sensorium, and hearing loss, one had cranial nerve palsy and three had peripheral weakness. All the cases had pleocytic CSF changes and Br. melitensis types 2 and 3 and Br. abortus type 4 isolated from their blood and all but one had same Brucellae isolated from their CSF. All cases had high titers of anti-brucella antibodies raised both in the serum and CSF though the Rose Bengal and ELISA tests. The treatment given was different of two or three combinations of Rifampin, Tetracycline, Cefotaxim, and Streptomycin for eight weeks up to four months for those with lumber osteomyelitis and epidural abscess cases. The outcome of cases was satisfying; four cases were cured without sequale, one case with cerebral abscesses was died and one case developed hearing loss and peripheral nerve weakness. It can be concluded neurobrucellosis is a treatable disease with a favorable outcomeexcept when there is a myelopathy or deafness and careful awareness of the disease as it is not an uncommon complication of common and treatable disease in our community is required.

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